Leading Indian research body looks for reasons behind CKDue prevalence in North Central region of Sri Lanka

Rules out heavy metals in drinking water as a probable cause

New Delhi-based research and advocacy non-profit Centre for Science and Environment (CSE) has conducted tests to ascertain the causes behind growing prevalence of Chronic Kidney Disease of unknown etiology (CKDue)

Findings of the CSE study released in Anuradhapura by Sri Lanka’s minister for water supply and drainage, Dinesh Gunawardene

At present, CKDue affects over 15,000 people in the North Central region, especially in the districts of Anuradhapura and Polonnaruwa

Study rules out heavy metals in water as the cause for the disease. However, finds that people in the affected areas were drinking relatively poor quality water with high levels of hardness, calcium, TDS and fluoride

Calls for provision of better medical facilities and clean drinking water to villages to reduce their dependence on poor quality groundwater

Anuradhapura, Sri Lanka, August 16, 2012: Way back in the 1990s, Sri Lanka’s North Central Province had come in the news for an emerging health crisis: experts noted endemic occurrence of Chronic Kidney Disease of unknown etiology (also referred to as CKDue) in this dry zone. Two key districts -- Anuradhapura and Polonnaruwa – were found to be severely affected.

Over the years, incidence of CKDue has increased and spread to the adjoining provinces -- North Western, Uva, Eastern, Central and Northern. The affected area now covers approximately 17,000 sq km, holding a population about 2.5 million in which more than 95 per cent live in rural areas. Over 15,000 people are being treated at present for CKDue.

Studies done to ascertain the causes behind prevalence of CKDue have come up with various theories – linking the disease that leads to renal failure, to the presence of arsenic, cadmium or fluoride in water, among other things.

Centre for Science and Environment (CSE), the New Delhi-based research and advocacy body,decided to help by joining in the search. CSE’s Pollution Monitoring Laboratory collected and analyzed 35 water samples from the key CKDue-affected areas -- Hingurukgoda and Medirigiriya in Polonnaruwa district; Padaviya, Medawachchiya and Kabithigollawa in Anuradhapura; Dehiattakandiya in Ampara; and Girandurukotte and Mahiyanganaya in Badulla. Five water samples were also collected and studied from the non-affected areas of Kandy district.

In addition to this, 16 soil samples, six rice plant and grain samples, five pesticide samples and three fertilizer samples were also collected from the endemic areas and analyzed for their arsenic content.

The findings of the CSE study were released here today by Sri Lanka’s minister for water supply and drainage, Dinesh Gunawardene, in a public meeting which was jointly organised by CSE, the Sri Lankan Ministry of Water Supply and Drainageand the Centre for Environmental Justice, Colombo.

Speaking on the occasion, Gunawardene supported the approach that CSE recommended: he said that providing clean drinking water and good medical facilities was the primary solution to the problem, and that the President of Sri Lanka had a special interest in this issue and was trying to provide clean drinking water to villages. The minister also said that he believed research should continue to find the actual reasons behind the uncommonly high prevalence of the disease in the region. “We need to do research on pesticides and fertilizers and their impacts. Water and soil are interconnected and these studies should be done,” he said.

The minister hoped the Sri Lankan government would continue to work together with CSE and similar organizations to find a solution to the issue.

What did CSE find
The CSE lab’s aim was to analyze drinking water quality for physico-chemical parameters and heavy metals in affected and unaffected regions. Samples of soil, food commodities (rice grain and plant), pesticides and fertilizers were also tested for arsenic to understand the linkage of arsenic with CKDue.

The key results of the analysis are as follows:

Total Dissolved Solids (TDS) exceeded the maximum desirable levels of 500 ppm in six out of 40 water samples – five of dug-well water and one of tube-well water, all in affected areas. The mean TDS level in all water samples of the affected area was 271.3 ppm as compared to 113.2 ppm in the unaffected area.

Hardness exceeded the maximum desirable level of 250 ppm in 14 out of 40 water samples -- 11 of dug-well water and three of tube-well water -- all but one from the affected areas. The mean hardness level in all water samples of the affected area was 225.8 ppm as compared to 136 ppm in the unaffected area.

Calcium exceeded the maximum desirable level of 100 ppm in nine out of 40 water samples – seven of dug-well water and two of tube-well water, all from the affected areas.The mean calcium level in all water samples of the affected area was 70.7 ppm as compared to 43.2 ppm in the unaffected area.

Alkalinity exceeded the maximum desirable level of 200 ppm in the five out of 40 water samples – four of dug-well water and one of tube-well water, all from the affected areas. The mean alkalinity level in all water samples of the affected area was 95 ppm as compared to 26 ppm in the unaffected area

Fluoride levels exceeded the maximum desirable level of 0.6 ppm in 22 out of 40 water samples -- 15 of dug-well water, five of tube-well water, one from municipal supply and one tank water sample. One tube-well water sample from Polonnaruwa exceeded the maximum permissible level of 1.5 ppm. The mean fluoride level in all water samples of the affected area was 0.8 ppm as compared to 0.5 ppm in the unaffected area.

The other parameters tested were for pH, chloride, sulfate and magnesium. In all the 40 water samples, these parameters were found to be within the maximum desirable levels prescribed for drinking water under SLS 614:1983.

Cadmium, arsenic, chromium and lead were not detected in drinking water samples collected either from the affected area or from the unaffected area.

Arsenic was present in 16 soil samples in the range of ‘Not Detectable’ level to 0.28 ppm.The levels of arsenic found in the soil samples of the affected and unaffected areas of Sri Lanka are well within permissible levels prescribed by the US Agency for Toxic Substances and Disease Registry (7.2 ppm) and the European Community (20.0 ppm). Also, the difference in the arsenic levels in the soil samples of the affected and the unaffected areas are not significant.

Arsenic was not detected in rice grain and rice plant samples samples collected from the affected region.

Arsenic was detected in the range of 0.009 to 0.254 ppm in 5 most commonly used pesticides—insecticide, weedicide and fungicide. The levels detected are very low and suggest that arsenic is likely to be present as an impurity from other ingredients rather than adulteration of these products.

Arsenic was detected in the range of 0.09 to 0.406 ppm in fertilizer samples – Urea 0.203 ppm, TSP 0.406 ppm and MOP 0.090 ppm.The levels detected are very low and suggest that arsenic is likely to be present as an impurity from other ingredients rather than adulteration of these products.

The samples of pesticides and fertilizer were randomly selected and the sample size was small. A larger study on the agrochemicals needs to be done conclusively establish the levels of arsenic in them.

Says Chandra Bhushan, CSE’s deputy director general: “What this study shows is that heavy metals – cadmium, chromium, arsenic and lead -- in drinking water are not linked to CKDue in the North Central region of Sri Lanka. However, we are not ruling out heavy metals. If heavy metals are responsible, then there is a different source for them than the drinking water and that source should be explored.”

The CSE study found that parameters such as TDS, alkalinity, hardness, calcium and fluoride were higher in groundwater (dug-well and tube-well) samples than the samples collected from tanks, municipal supply, springs and river. People in the affected areas of Ampara, Badulla, Polonnaruwa and Anuradhapura were consuming water directly from groundwatersources.

Adds Chandra Bhushan: “We also clearly establish that people in the affected areas are consuming poor quality water than those from the unaffected areas.”

What can be done
CSE recommended that:

Efforts should be made to supply clean drinking water to villages so that their dependence on unfiltered groundwater is eliminated.

Medical facilities in the affected area should be upgraded. Government should increase the number of mobile clinics so that patients can be diagnosed at an early stage and treatment can begin. Dialysis is critical. Enough dialysis sets should be made available in the district hospitals to ensure that patients do not have to travel far for their treatment.

The government of Sri Lanka should support further research on CKDue and its linkages with environmental and lifestyle patterns. It should also organize an annual symposium/ meeting and bring all the experts working on the issue of CKDue together to forge a way ahead.

New Delhi-based Centre for Science and Environment (CSE) is one of the foremost research and advocacy bodies working in the South Asian region on issues of environment and development. CSE’s Pollution Monitoring Lab has conducted some seminal studies on health and environment, and its work has had immense impact in driving policy as well as public opinion in India.